Why are hospitals penalized for readmissions?

Outline of the US with 72% shaded
77.2% of all eligible U.S. hospitals are penalized.¹

In 2018, 2,573 U.S. hospitals will be penalized¹

  • Medicare’s Hospital Readmissions Reduction Program (HRRP) requires CMS to penalize acute care hospitals for readmissions within 30 days of discharge for these admission types:
     

    • Acute myocardial infarction (AMI)
    • Heart failure (HF)
    • Pneumonia (PN)
    • Chronic obstructive pulmonary disease (COPD)
    • Elective total hip arthroplasty (THA)
    • Total knee arthroplasty (TKA)
    • Coronary artery bypass graft (CABG) surgery

Large, safety-net hospitals, academic medical centers and non-profit hospitals are often on the penalty list.²

  • Icon of a large hospital
    89.2% Large hospitals
  • Icon of a medium-sized hospital
    84.7% Teaching hospitals
  • Icon of a small hospital
    81.7% Non-profit hospitals

And there’s another often untold story behind readmissions: Patients with mental health or substance abuse concerns.

Icons of a person and medications within a partial circle outline

84.2% of hospitals with dedicated psychiatric services are penalized for readmissions.²

Outline of Rhode Island next to two arrows pointing up

For example, risk of readmission doubles in Rhode Island when mental health or substance abuse comorbidities are present.³

Arrow pointing up at an angle

Mental health or substance abuse = Significantly higher potential for readmissions

Top 3 initial admissions leading to preventable readmissions:⁴

  • a bar representing 21%

    1. Schizophrenia: 21%

  • a bar representing 15.8%

    2. Bipolar disorders: 15.8%

  • a bar representing 12%

    3. Major depression: 12%

outline of Florida

27.4% of potentially preventable readmissions in Florida are related to mental health and substance abuse.⁴


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  • Notes: 1 Readmission numbers and penalty information provided by CMS: https://www.cms.gov/Medicare/Medicare-Feefor-Service-Payment/AcuteInpatientPPS/Downloads/FY2018-CMS-1677-FR-Table-15.zip 2 Hospital profile data were derived from the American Hospital Association’s AHADataviewer and then matched with the CMS penalty data referenced above. 3 See section 3.9 of “Potentially Preventable Readmissions in Rhode Island” study (April 28, 2014): http://www.ohic.ri.gov/documents/RI-Potentially-Preventable-Readmissions-2014-04-28.pdf 4 Florida Medicaid Management Information System (FMMIS) Eligibility, Encounter, and Claims Information, August 2014 - July 2015, page 21: http://ahca.myflorida.com/Medicaid/Finance/data_analytics/BI/docs/Quarterly_ SMMC_Report_Spring_2017.pdf